ALIVIA JONES
Greenville
Summary
Detail-oriented and results-driven Claims Specialist with over 7 years of experience in insurance follow-up, claims resolution, and revenue cycle management. Skilled in analyzing, auditing, and resolving outstanding and denied claims while ensuring compliance with Medicare and third-party payer regulations. Adept at communicating with insurance carriers, handling patient billing inquiries, and improving claims processing efficiency.
Overview
7
7
years of professional experience
Work History
Customer Service Advocate
Centene, Superior Health Services
08.2025 - Current
- Researched and resolved customer account issues, ensuring accurate and timely problem resolution
- Reviewed account histories, transactions, and documentation to identify discrepancies and determine appropriate solutions
- Communicated with internal departments and external clients to gather information and resolve complex issues
- Maintained detailed and accurate records of customer interactions and account updates
- Handled high-volume calls while maintaining professionalism and attention to detail
- Identified recurring issues and escalated concerns to management for process improvement
Patient Care Coordinator
Aerotek
01.2021 - 01.2025
- Entered and updated customer and medical records into company databases with a 99% accuracy rate.
- Verified eligibility and assisted patients with scheduling appointments, verifying insurance coverage, and understanding their benefits.
- Reviewed and processed medical claims, ensuring accuracy and compliance with insurance regulations.
- Educated patients on billing statements, payment options, and financial assistance programs.
- Ensured proper documentation of patient interactions, claims follow-ups, and appeals in the electronic health record (EHR) system.
Claims Reimbursement Specialist
IQVIA
12.2018 - 12.2020
- Analyzed, audited, and resolved outstanding, denied, or incorrectly paid claims to ensure accurate and timely reimbursement.
- Submitted appeals for denied claims, following payer guidelines and Medicare regulations.
- Contacted insurance companies and navigated payer websites to expedite insurance payments.
- Met productivity expectations by efficiently managing claims workflow and meeting deadlines.
- Utilized CRM tools to manage customer accounts and resolve escalated inquiries efficiently.
Education
High School Diploma - undefined
James Hunt High School
Wilson, NC01.2017
Skills
- Claims Analysis & Resolution
- Revenue Cycle Management
- Data Entry
- Insurance Appeals & Follow-Up
- Medical Billing & Coding (ICD-9, ICD-10, CPT-4)
- EOB Interpretation
- Customer Service & Support
- Technical Troubleshooting
- Time Management
- Microsoft Office, Word, Excel
- Salesforce
- Professional telephone demeanor
- CRM Tool
- HIPPA
- Medicaid
Timeline
Customer Service Advocate
Centene, Superior Health Services
08.2025 - Current
Patient Care Coordinator
Aerotek
01.2021 - 01.2025
Claims Reimbursement Specialist
IQVIA
12.2018 - 12.2020
High School Diploma - undefined
James Hunt High School